No Answers Yet For Problems With ASV

I don't know whether this feels more like spitting into the wind or pissing into the wind?

EPAP Min 8
EPAP Max 8
PS Min 4
PS Max 4
Max Pressure 25

or

EPAP Min 8
EPAP Max 0
PS Min 4
PS Max 4
Max Pressure 25

Should get you to 8/12 BiPAP mode..

Deleted - Repeat post

StillAnotherGuess wrote:I don't know whether this feels more like spitting into the wind or pissing into the wind?

Mayhap it is like projectile vomitting into the wind.

StillAnotherGuess wrote:EPAP Min 8
EPAP Max 8
PS Min 4
PS Max 4
Max Pressure 25

or

EPAP Min 8
EPAP Max 0
PS Min 4
PS Max 4
Max Pressure 25

Should get you to 8/12 BiPAP mode..

Where is the Max Pressure of 25 coming from? If 8/12 means that the IPAP is 12 and if Max Pressure = IPAP, then why isn't Max Pressure = 12?

I just tried out those settings (with Max Pressure= 12) and it worked. My machine was compliant and cooperative and had no apparent problem.

edit to add information after trying those settings on my machine.

Paper_Nanny wrote: When the question of how to set my old machine as a BiPAP came up, BrianinTN came up with the following settings. BPM to Auto; PresMax to 25; EPAPmax to 15; EPAPMin to 8; PSmax to 15; PSmin to 0.

On Thu Jun 16, 2011 at 3:57 pm

BrianinTN wrote:You can make your ASV act (pretty much) just like a standard BiPAP. You'd set your min PS and your max PS to the same value, set your max pressure to your desired IPAP pressure, and turn your backup rate off. (If you wanted it to behave like a BiPAP S/T rather than a standard BiPAP, you'd set a backup rate.)

Using the above infomration, can someone tell me how to set my machine for 8/12?

I got the first one okay. BPM- Off.

I believe that first set of numbers must be for something else, because it doesn't line up with my text in the second paragraph. Either that or I was having a crazy day, which happens too. To get a 12/8 standard BiPAP, you'd be looking at:
BPM = Off
Min EPAP = 8
Min PS = 4
Max PS = 4
Max EPAP = 8 *and/or* Max Pressure = 12 (In theory, from a pure math standpoint, either of those constraints should lead to the same functional outcome. In practice, I have no empirical data.)

Paper_Nanny wrote:Where is the Max Pressure of 25 coming from? If 8/12 means that the IPAP is 12 and if Max Pressure = IPAP, then why isn't Max Pressure = 12?

I just tried out those settings (with Max Pressure= 12) and it worked. My machine was compliant and cooperative and had no apparent problem.

You are definetly smarter than a 5th grader!

BrianinTN wrote:

Paper_Nanny wrote: When the question of how to set my old machine as a BiPAP came up, BrianinTN came up with the following settings. BPM to Auto; PresMax to 25; EPAPmax to 15; EPAPMin to 8; PSmax to 15; PSmin to 0.

On Thu Jun 16, 2011 at 3:57 pm

BrianinTN wrote:You can make your ASV act (pretty much) just like a standard BiPAP. You'd set your min PS and your max PS to the same value, set your max pressure to your desired IPAP pressure, and turn your backup rate off. (If you wanted it to behave like a BiPAP S/T rather than a standard BiPAP, you'd set a backup rate.)

Using the above infomration, can someone tell me how to set my machine for 8/12?

I got the first one okay. BPM- Off.

I believe that first set of numbers must be for something else, because it doesn't line up with my text in the second paragraph. Either that or I was having a crazy day, which happens too.

No, not your crazy day, Brian. It is mine. You are correct that the first set of numbers was not what you had said on how to set my machine as a BiPAP. I did go back and mark that as an error on my part in my original post. That first set of numbers is the original setting on my BiPAP ASV. Not the same things as setting it as a BiPAP!!

I think the numbers you came up with for BiPAP setting were: PressureMax of 12; EPAPmax of 12; EPAPmin or 8; PSmax and PSmin of 4. Does that look better???

Paper_Nanny wrote: I think the numbers you came up with for BiPAP setting were: PressureMax of 12; EPAPmax of 12; EPAPmin or 8; PSmax and PSmin of 4. Does that look better???

Change "EPAPmax of 12" to "EPAPmax of 8" and you're there. (Although as I was alluding to in my previous post, with these settings, EPAPmax won't actually matter because you've placed a realistic and real constraint on PressureMax=12. In other words, you've told it that IPAPmax=12, and EPAPmin=8, and the pressure support gap MUST ALWAYS BE 4, so the EPAPmax setting is functionally not relevant. Had you left PressureMax at a default of 25 or 30, only then you would need to set EPAPmax=8.)

As you can probably see by now, there's more than one way to skin a cat. Because these are all mathematical constraints, and some have dependencies on others, there are sometimes multiple ways to configure the settings to arrive at the same outcome. From what I read in your preceding post, I think you're already there without any further tinkering. Whee!

Paper_Nanny wrote:I know I need to have a sharp pharmacist go over my medication list with me. I know I have to get raw data and a shiny DVD from the sleep lab. I know I need to get an order for a MIF MEF NIF. (GNIP GNOP, anyone?)

I called the Sharp Pharmacist and asked her to go over my medication list to identify drugs likely to cause problems with sleep (eg delaying REM) and to suggest alternatives to those medications.

I sent an e-mail to the RT at the sleep lab requesting some representative 30 second epochs from both studies, a bird's eye view from some 300 second epochs, and if the software used at the lab calculates “REM Dnesity”, a copy of that information.

I also had, "one other request. Do you still have the video taken of my room when I was sleeping during the titration study? If so, would it be possible to get a copy of that on a DVD?"

I will ask MSD for the GNIP PNOP MIF and MEF at my appointment in August.

I will set my machine to function like a BiPAP tonight.

I ate some rhubarb sauce on my oatmeal this morning. Maybe I am not as messed up as I thought I was.

Deborah

BrianinTN wrote:As you can probably see by now, there's more than one way to skin a cat.

And the cat doesn't like any of them.

BrianinTN wrote:Whee!

Yes, whee! indeed.

Meow. I hate cats anyway.

Deborah,

These periods of frustration are normal. It is a lot to take in and few if any can do it all in one go no matter how smart we like to feel we are. It is pure overload.

There is a risk period where all the suggested settings start to create utter confusion. This happens because we think we understand a particular setting then someone puts forward a reason why it isn't. There is an old saying that is so applicable to xPAP therapy & it relates to kitchens & cooks.

NotMuffy has been offering you sound professional advice. Many of us have offered you comfort & thoughts on the therapy. Some are suggesting ways to wing the dials on your machine & that is right where you are at the moment in a dial-winging phase that is creating confusion.

Move carefully. Listen to your adopted professional.

DSM

StillAnotherGuess wrote:I don't know whether this feels more like spitting into the wind or pissing into the wind?

EPAP Min 8
EPAP Max 0
PS Min 4
PS Max 4
Max Pressure 25

Should get you to 8/12 BiPAP mode..

Also, I missed this one earlier. This one would be functionally impossible as well. EPAP max cannot be set to a value less than EPAP min.

dsm wrote:Some are suggesting ways to wing the dials on your machine & that is right where you are at the moment in a dial-winging phase that is creating confusion.

It's a bit OT, but I think that nearly all of us who have been commenting in this thread have explicitly avoided dial-winging, and many of us have counseled explicitly against it. Ozij, I, and a couple others have answered questions about how one could configure an ASV to produce a particular modality-type outcome, but we've been pretty careful to avoid making normative statements about what Paper_Nanny should do. We've left that to NotMuffy and her medical team.

If I were Paper_Nanny, the questions I would be struggling with right now (outside of the logistical issues with changing PS on her new S1 ASV) would be:
1) Should I continue with the constant pressure-type approach but try a lower pressure in the hopes that it would ameliorate the central apneas? or
2) Should I try some other bilevel-type approach?
3) Given that NotMuffy said "BTW, I am not a big 'Auto' breath rate fan," regardless of the choice between (1) and (2), what should I do with that sucker?

I think our discussion on (2) for the last page or so has largely been logistical -- i.e., what would be the settings required to achieve that -- rather than most of us normatively claiming that Paper_Nanny should or should not.

BrianinTN wrote:In other words, you've told it that IPAPmax=12, and EPAPmin=8, and the pressure support gap MUST ALWAYS BE 4, so the EPAPmax setting is functionally not relevant.

I do not believe that to be technically correct. Increasing EPAPmax would force a decrease in PSmin such that IPAPmax - EPAPmax = PSmin.

The answer provided for the ESS will be an explanation instead of a number.

NotMuffy wrote:

BrianinTN wrote:In other words, you've told it that IPAPmax=12, and EPAPmin=8, and the pressure support gap MUST ALWAYS BE 4, so the EPAPmax setting is functionally not relevant.

I do not believe that to be technically correct. Increasing EPAPmax would force a decrease in PSmin such that IPAPmax - EPAPmax = PSmin.

Ooo, you are right, you smart cookie, err, muffin! So once you enter the settings I originally described and confirm them, and then go back in, get to the EPAPmax screen, and increase it (e.g., from 8 to 9), it does indeed lower PSmin all by itself (e.g., from 4 to 3).

Edit: PSmin is a screen that appears after EPAPmax, so it makes sense that the ASV is enforcing a certain order of operations when applying logic. So it doesn't matter at all whether you input the settings and then go to adjust EPAPmax, or merely go through them one at a time. Same result as what NM said.

Edit2: For anyone who cares about that order of operations, it is: PresMax, EPAPmin, EPAPmax, PSmin, PSmax.